{
"Npi": {
"NPI": "1114255015",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HEALTHY FAMILY DENTISTRY PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5350 W HILLSBORO BLVD",
"SecondLineMailingAddress": "SUITE 201",
"MailingAddressCityName": "COCONUT CREEK",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33073-4396",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-478-0858",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5350 W HILLSBORO BLVD",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "COCONUT CREEK",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33073-4396",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-478-0858",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/03/2009",
"LastUpdateDate": "12/03/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRUCES",
"AuthorizedOfficialFirstName": "MANUEL",
"AuthorizedOfficialMiddleName": "IGNACIO",
"AuthorizedOfficialTitle": "VICE PRESIDENT - DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "954-478-0858",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "DN18716",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}